“Viewpoints” | Looking Back at Hurricane Katrina: Is Our Public Health System More Prepared?
Four years ago this week – August 28, 2005 to be precise – Hurricane Katrina slammed into the Gulf Coast region, killing more than 1,800 people and causing more than $81 billion in damages. The devastating storm left the region’s public health and health care systems in shambles from which they are still trying to recover years later.
At the time, many Americans considered Katrina a wake-up call for federal, state, and local governments to seriously prepare the country for public health emergencies and natural disasters. Instead, we treated Katrina like a snooze alarm: it grabbed our attention at the time, but we quickly returned to a state of complacency.
And it is complacency that is one of the biggest challenges facing public health emergency preparedness. Without a sense of urgency, it’s easy for federal, state, and local governments to direct limited resources to other areas. In fact, federal funding for state and local emergency preparedness has declined by 25 percent since 2005. On top of that, nearly every state is facing a budget crisis brought on by the current economic recession.
Without adequate funding, gains in public health emergency preparedness are seriously threatened. Funding cuts frequently result in workforce reductions or hiring freezes. Already, thousands of state and local public health positions have been eliminated, according to surveys of health departments. These officials warn of more cuts over the course of the year.
These cuts undermine our public health workforce and infrastructure at a time when we not only remember the fourth anniversary of Hurricane Katrina but also face the ongoing threat of another public health emergency: the global A/H1N1 influenza pandemic, which may become more virulent during the upcoming fall flu season. Scientists and public health officials are working on the development of an A/H1N1 vaccine and figuring out how to implement plans to carry out a mass vaccination campaign.
However, if A/H1N1 mutated and became more deadly, it would quickly overwhelm the U.S. public health and health care system. It would also have a devastating effect on our nation’s economy. In 2007, my organization, Trust for America’s Health, released a report which found that during a severe pandemic flu outbreak, the U.S. Gross Domestic Product could drop more than 5.5 percent, leading to an estimated $683 billion loss. Coming on the heels of the worst economic downturn since the Great Depression, this would be disastrous.
So what can we do to help prevent this worst-case scenario?
A major concern during a pandemic is our health system’s ability to handle a sudden, large influx of patients. Experts have coined this concept “surge capacity.” While the initial A/H1N1 outbreak was relatively mild, hospitals and clinicians across the country reported major surges in patients, including individuals with the flu; individuals with flu-like symptoms; and the “worried well” who were not sick at all. As health providers prepare for a potential return of A/H1N1 in the fall, caring for a major surge of patients remains one of the most difficult challenges for public health and health care systems.
In a public health emergency, such as pandemic flu, U.S. hospitals and health care facilities will be on the front lines, providing triage and medical treatment to individuals. In the best of times, however, most emergency rooms must confront bed shortages and staffing issues; in a mass casualty event the situation could quickly spiral out of control.
Hospitals won’t be the only place people receive care, so our planning needs to include alternate care sites, whether school gyms, community centers, or hospital parking lots. Officials must have a plan to staff these facilities adequately.
Our emergency preparedness planning needs to encompass workforce capacity. Whether we increase capacity through the use of incentives for current staff or through the recruitment and the appropriate training of health care volunteers, these systems need to be developed and in place before the next major disaster strikes.
Finally, we need to address how we will pay for the coverage of the uninsured and underinsured. With more than 15 percent of Americans lacking health insurance coverage, the financial impact on the country’s public health and health care systems could be disastrous if hospitals, community health centers, and primary care facilities treat large numbers of uninsured. Likewise, if uninsured or underinsured patients hesitate to seek treatment because of fears of out-of-pocket costs, treating and containing the further spread of a pandemic would be nearly impossible.
Despite these major challenges that still need to be addressed, there is some good news to report on progress we have made on pandemic and all-hazards preparedness. For the past six years, Trust for America’s Health has released a report on federal and state public health emergency preparedness, Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism. In our 2008 report, we highlighted some major gains in state preparedness over the past six years. Examples include:
- In 2003, only 13 states had a pandemic influenza plan. Today, all 50 states and D.C. have developed one.
- In 2004, only 21 state public health labs had adequate staffing to provide 24/7 coverage to analyze samples in an emergency. As of 2007, 49 states had this capacity.
- In 2005, only seven states had a Centers for Disease Control and Prevention-approved plan in place to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile. Today, all 50 states and D.C. have one.
- In 2006, 38 states maintained or increased seasonal flu vaccination rates among adults age 65 and older. In 2008, all 50 states and D.C. were able to maintain or increase seniors’ flu vaccination rates.
- In 2007, only 29 states and D.C. had liability protections for health care volunteers during times of emergency. Today, 42 states and D.C. offer these liability protections.
Despite these strides, we still have a number of tough questions to ask ourselves as we prepare for what could be the next national emergency.
We need to have a serious national discussion about disaster standards of care. What kind of care can we provide with limited resources, staff, and supplies? Although various federal agencies have published guidance on disaster standards of care, there have been few incentives or unified directions to enable states to implement planning.
Tackling these challenging issues will require the collaboration of public health and medical professionals and a whole range of stakeholders, including state and local officials, religious leaders and ethicists, the business community, organized labor, schools, and community groups.
It shouldn’t take another Katrina for us to hold these discussions and move our preparedness forward. But until we address these major gaps in our nation’s preparedness, we will remain vulnerable to repeating this sad chapter in America’s story.
“Viewpoints” blog postings are intended to allow non-Altarum Institute authors to pose their own opinions and policy positions in the realm of health care and health policy. As a leading nonprofit health care research and consulting institute dedicated to improving human health, Altarum encourages open discussion and debate about the many challenges in health care today. All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions. Read more.
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